Episode 9: Let My Doctor Practice, Policy Innovation, & Direct Primary Care with with Dr. Beth Haynes, Director of the Benjamin Rush Institute
*You can skip ahead & Listen to the FULL interview RIGHT HERE!
- Bob Graboyes — 4-minute video on How Innovation can save Healthcare
- Sally Pipes — “The Way Out of Obamacare”
- Pamela Wible — TEDMED talk on “Why Doctors Kill Themselves”
- Colin West, MD/PhD — expert at Mayo Clinic on physician well-being
- Dick Armstrong, Navy surgeon
Startups & Companies mentioned
- AliveCor — “keep living”
- Free Market Medical Association — “join the healthcare revolution”
- Epharmix — “improve health outcomes with just a phone number” [created by fellow BRI leader Eric Sink — here’s his explanation]
- AtlasMD — “DirectCare’s premier EMR” [created by Dr Josh Umbehr]
- Docs 4 Patient Care — “preserving sanctity of doctor-patient relationship”
- Pacific Research Institute — “individual freedom & personal responsibility”
- Let My Doctor Practice — “it’s time to restore the physician’s voice”
- Supreme Court case on the “individual mandate”
- Quadruple Aim — “The Cure for Doctor Dropout”
- Canadian multiple-mini interview (full list of med schools using it here)
GUEST: Dr. Beth Haynes, President of Benjamin Rush Institute (BRI)
[3:20] Recent BRI Conference
We convened students from 20+ professional medical schools in America and abroad. Three students came from Nigeria, where they work with a fee-for-service doctor who powers his autoclave by burning corncobs. He even built his own surgical table using a carjack, like MacGyver.
[6:30] How I got involved with BRI
I took a few years off from my ER practice, was helping family and neighbors, and as I got ready to start up again with a cash-based palliative care practice, the government passed the ACA. The people drafting the law weren’t even considering the doctor-patient relationship, a real tragedy.
Sally Pipes had incubated the Benjamin Rush Institute within her nonprofit, and when she asked me to be Executive Director, I jumped at the chance.
“Souls are like athletes — they need opponents worthy of them.”
[9:45] How I met Sally
Sally Pipes is a Canadian economist who trained with Milton Friedman and runs the Pacific Research Institute in California. Her mother DIED because she couldn’t get a preventive colonoscopy until she developed severe bleeding, which she attributes to the socialized medicine system in Canada.
We worked together on submitting an amicus brief for the repeal case in Florida and eventual Supreme Court case on constitutionality of the “individual mandate”: National Federation of Independent Business v. Sebelius. I had been volunteering in public policy for 4 years and then, suddenly, I could get paid to keep doing it.
[12:30] Training in Everything
A medical specialty was hard to choose because I loved it all. I trained in family practice, surgery, broken bones, stitching people up, managing diabetes. When we moved out to California, urgent care wasn’t available, so I would up doing rural-care shift-work in Los Banos, Willits, and Los Gatos.
In our small hospital, the camaraderie was amazing — I knew the nurses, the doctors, the patients, everyone. I was homeschooling my two kids at the time and my parents started getting sicker, so that’s what spurred the break.
[16:30] Training in Everything
Keith Smith calls the ACA the Unaffordable Care Act.
“I just use the acronym ACA since I can’t bring myself to say the words ‘Affordable Care Act’ — because it’s not.”
Insurance Premiums are going up, WAY UP relative to the decreasing value that patients are getting from their plans.
“Affordability doesn’t have anything to do with how much care is costing an individual patient. We measure the overall cost to provide a certain amount of care, and that number is only going up.”
[20:45] Examples of Innovation
I love the work of Bob Graboyes in this area. [Check out his 4-minute video here: “From Fortress to Frontier: How Innovation can save Healthcare”.] He talks about the example of a doctor who partnered with an engineer to design 3D-printed artificial hands, make them available for just $25. I personally also really like the AliveCor — a basic band with single-lead EKG that works through the microphone. Tiny handheld ultrasounds will also be groundbreaking in the near future and as we train more technicians.
[23:45] Policy Priorities
If you try to start or expand a physician-owned hospital right now, you’ll lose your contract with (or ability to be reimbursed by) Medicare. We need to get that rule changed and OFF the books.
Right now I’m working with state legislative bodies to make sure that DPC practices are not registered as (hence regulated as) insurance agencies, essentially a risk-bearing entity. We were successful in Michigan. Louisiana also was able to reverse course from their older, outdated policy recently.
[29:30] Check out the FMMA
The Free Market Medical Association brings together all the groups needed to make sure that employers can self-insure: essentially combining the cheaper catastrophic health insurance plan with direct pay subscription to save money and also create a higher-value product.
[31:30] Other exciting projects
Here are two. The Doctor Joseph Warren Institute trains physicians to be effective spokespersons for their patients and even to run for public office. The United Physicians & Surgeons of America runs a big summit called “Let My Doctor Practice” in Keystone, CO.
Next year’s BRI conference will be on the topic of “Healing the Healers”.
- Check out Pam Wible’s TEDMED talk on “Why Doctors Kill Themselves” — 400 per year, a higher rate than most other professions in America.
- Also check out VC Dave Chase’s take on “The Cure for Doctor Dropout” — using the Quadruple Aim he’s written about in Forbes Magazine.
Healthy citizens are the greatest asset any country can have. ― Winston S. Churchill I can't think of a time in history…www.forbes.com
[36:30] What I Hire For
(1) Passion for the basic mission of BRI — keeping government small — is key. (2) Willingness to learn. (3) Work ethic. (4) Accountability. (5) Honesty.
[41:00] Communication Platforms to Invest in
- Epharmix: created by Eric Sink
- AtlasMD: created by Dr Josh Umbehr
- Ambulatory centers based on Keith Smith’s model
“Health insurance wasn’t meant to pay for all your medical care — it’s not for predictable, routine needs. You don’t bill your car insurance every time you fill up on gas, check oil, or get windshield wipers replaced. We don’t need that kind of health insurance for the same reason we don’t have grocery insurance. Yes, it’s necessary for life; but no, that would just make everything more expensive.”
Med school interview styles: a few dozen U.S. schools now use the Canadian multiple-mini interview (see full list here). I would up needing to be proficient in this style for a majority of mine like at Duke, Virginia Tech, and the University of Cincinnati — where Dr. Haynes went for med school.
*starting at [45:00]
- Whose FACE first pops into your head when you hear ‘The Ultimate Doctor’? Dick Armstrong, Navy surgeon + Docs 4 Patient Care
- What single daily HABIT is most key to your success? Getting up early, gathering my thoughts, and making a daily list of Urgents + Not. I work out with a trainer, take voice lessons, go for walks on the beach, and have a zillion things to do that couldn’t get done without that list. [Eben Pagan says to work in 60–90 minute blocks with 30-minute breaks.]
- What book do you recommend or give as a gift most often? Changes all the time, but right now they would be: The Conservative Heart by Arthur Brooks. Catastrophic Care by David Goldhill.
- If you could put up a billboard anywhere, what would it say? “You are Responsible for your Own Happiness”
- Which mentor have you learned the most from? My husband. We’ve been together for 41 years, and he challenges me in all the right ways.
- What single thing do you want to be remembered for? That I’m having fun.
“Come have fun with me!”
Connect with Beth right here! email@example.com
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